Descending necrotizing mediastinitis: etiopathogenesis, diagnosis, treatment and long-term consequences—a retrospective follow-up study

Abstract

Purpose The primary aim of this retrospective study was to analyze the progression of descending necrotizing mediastinitis (DNM), evaluate the impact of comorbidities on complications and mortality and to observe long-term consequences of DNM on dysphagia and measurements quality of life. DNM is a serious infectious disease that requires multimodal treatment. Current literature varies in conclusions of risk factors, management and outcome of DNM. In addition, little is known about persisting effects on quality of life. Methods Retrospective data analysis of 88 patients with DNM representing the largest single-center study. Recording data of patients and diseases as well as clinical progression from 1997 to 2018. Two questionnaires were sent to the participants to measure quality of life and to detect dysphagia. Results 88 patients were included. The most frequently found pathogen were Streptococcus spp. (52%). 75% of the patients underwent multiple surgeries, mean count of surgical procedures was 4.3 times. 84% received intensive care treatment. Median length of stay on the intensive care unit was 7 days. 51% had pre-existing comorbidities associated with reduced tissue oxygenation (e.g., diabetes). The most common complication was pleural effusion (45%). During the observation period, the mortality rate was 9%. 12 questionnaires could be evaluated. 67% of the participants were affected by dysphagia at the time of the survey. Conclusions Descending necrotizing mediastinitis (DNM) is a severe disease requiring an immediate initiation of multimodal treatment. Although quality of life usually isn´t impaired permanently, dysphagia may often persist in patients after DNM.

Mimicking descending necrotizing mediastinitis as acute myocardial infarction in a patient with severe coronary artery disease: A case report

“…[9,10] Effective management of DNM involves the use of appropriate antibiotics, as well as the essential procedures of debridement and drainage. [9][10][11] Ischemic type chest discomfort, dyspnea, nausea, unexplained weakness, or a combination of these symptoms imply AMI. [12] Upon the commencement of clinical history-taking, an ECG and serum troponin test are performed to diagnose the condition when a patient presenting at the emergency room complains an acute chest pain.…”

“…[ 9 , 10 ] Effective management of DNM involves the use of appropriate antibiotics, as well as the essential procedures of debridement and drainage. [ 9 – 11 ]…”

A Machine Learning Approach to Assess Patients with Deep Neck Infection Progression to Descending Mediastinitis: Preliminary Results

“…The dissemination of the DNI to the mediastinum can be facilitated by gravity, the pressure of the abscess, and negative thoracic pressure during respiration [41]. The symptoms of descending mediastinitis include odynodysphagia, dyspnea, respiratory distress, chest discomfort, and fever, even though the patients would not necessarily present these clinical manifestations [42]. This infectious illness most often occurs in middle-aged males, especially those with damaged immune function as well as nutritional insufficiency.…”

Video-assisted thoracic surgery drainage is feasible and safe for acute necrotizing mediastinitis: a retrospective cohort study

“…Therefore, physicians should carefully review patients’ medical history, physical examination, and imaging examinations to accurately identify mediastinal abscess. Patients should be asked about characteristic clinical manifestations such as cervical swelling, cervical pain, and dysphagia ( 18 ). Among the imaging examinations, contiguous cervicothoracic CT is considered as the most reliable and accurate method for diagnosis.…”